Staph Infections

From Beachapedia

Introduction

Staphylococcus aureus, or S. aureus, is a common human bacterium that is probably living on your skin right now. A break in your skin can lead to a type of infection called a staph infection. Common staph infections result in boils (abscesses), often on the buttocks or legs, or styes on the eyelids. Staph infections can be deadly when they occur in the lungs, bloodstream or at a surgical wound site.

Surfers and other ocean recreationalists are subject to staph infections, particularly if wounds are not promptly and properly treated. A new, more resistant S. aureus strain has recently emerged, called Methicillin Resistant Staphylococcus aureus, or MRSA. Unlike the more treatable S. aureus, MRSA is resistant to many of the more common antibiotics, and is more successfully treated with only specialized antibiotics that are potentially toxic. In addition, MRSA can be more invasive, which means that it is more painful, destroys tissues faster and is more likely to cause large abscesses. Severe infection may require surgery including amputations. Fatalities have occurred.

MRSA began infecting patients in hospitals decades ago, and the number of hospital-acquired MRSA infections has steadily grown with time. MRSA infections have also become problematic in facilities such as nursing homes, sports team locker rooms and similar facilities. This variety of MRSA is known as Community Associated MRSA or CA-MRSA. The rise in MRSA cases may have been made worse by physicians who over-prescribe and patients who demand antibiotics when they are not indicated.

Although it's not clear if surfers are getting staph (including MRSA) infections from exposure to contaminated water (also see here and here) or whether open wounds from surfing simply allow staph acquired elsewhere to have an entry point into the body, these infections are a serious concern. The commonality of these infections to surfers and other ocean users is becoming alarming. MRSA has been cultured from the near shore waters and has been reported in storm and sewer waters as well. Thus the risk to surfers is storm water-related, like the other disease risks from surfing in brown waters. NEVER SWIM OR SURF WITHIN 48 to 72 HOURS AFTER A RAIN! Studies are also beginning to indicate that wet beach sand harbors many potential pathogens and staph may also reside there.

Former pro surfer Corky Carroll has written about the MRSA issue in his newspaper column. Here is a slightly edited version of what Corky's doctor says in the article:

A new development in the past several years has been the rise is a certain potentially serious staph. MRSA, for methicillin-resistant Staphylococcus aureus, is on the rise in the community, and possibly in the surf. When recognized and treated early, it's not serious.

The problem is that it is resistant to most antibiotics, with a couple of oral (pill) exceptions (sulfa-trimethoprim and sometimes rifampin and/or clindamycin). It can require IV treatment by potentially toxic antibiotics including vancomycin and some other newer, more experimental drugs. It can spread to other organ systems and lead to septic (infectious) shock, stroke and loss of cardiac, kidney and other functions.

Perhaps you're familiar with the case of Timmy Turner, which was in Surfer magazine. His story and some video of him are on the Web. He was treated at Hoag. It's still unclear, and there's little firm data on it, but it looks like soft tissue wounds and fresh tattoos in ocean waters can be a source of entry for getting the infection.

There is a carrier state in which a person has this staph in their nasal and/or sinus passages, which can flare up. [Note: Studies at the University of Hawaii and elsewhere suggest the strains of MRSA in infected wounds are distinct from the stains of staph about 50% of the population carry in their nasal passages.] So, now before surgery I take a nasal swab for culture and sensitivity studies. If it's positive, it's straightforward to get rid of with Bactroban cream applied inside the nose for 10 days, and/or by 10 days of oral antibiotics to which the culture shows sensitivity.

My own thought is that some surfers have acquired it, and due to good general health either don't have much or are carriers with no symptoms.

A word of caution to surfers -- for soft tissue lesions that enlarge, become red and sore like boils, it could be MRSA. Get them checked and cultured. Play it safe and stay out of the surf if you have any sores, cuts, lesions, fresh tattoos or recent surgical incisions.

The appearance of a MRSA infection may initially resemble that of a spider bite, in that there may be evidence of tissue destruction. The best prevention is good hygiene, including washing skin on a regular basis, using clean clothing and linens, and washing all cuts and scrapes thoroughly with soap and disinfected water. Using an antiseptic ointment, such as bacitracin or Triple Antibiotic ointment on open wounds may not prevent a MRSA infection, but will certainly help prevent other Staphylococcus infections and Streptococcus ("strep") skin infections.

More Detailed Information on Preventative Measures

How can I prevent staph or MRSA infections?

Most skin infections can be prevented with good hygiene.

Wash your hands well and often with soap and water, or use a hand sanitizer, especially after changing bandages or touching a wound.

Keep cuts and scrapes clean and covered with a bandage until healed. Avoid recreational water exposure (especially sea water) until wounds are healed, as constant moisture can delay healing and increase the risk of infection.

In areas with rocky or reef bottoms, a laceration should be cleaned as soon as possible with isopropyl alcohol or vinegar. This will kill the coral animals, protozoa and other critters that lodge in your skin and will reduce the chances that staph on your skin will infect the area.

Don't share personal items such as towels washcloths, razors, or clothing that may have had contact with an infected wound.

Clean sheets, towels, and soiled clothing with hot water and laundry detergent. Drying clothing in a hot dryer, rather than air-drying, will help kill bacteria in linens and clothing.

If you are an athlete, or someone who has frequent skin to skin contact with others, be extra careful with your personal hygiene. Be sure to shower well after games and practices and disinfect surfaces such as mats daily.

Contact your doctor if you have a skin infection that does not improve.

More Details on Sanitizing/Handwashing/Decolonization

Surface sanitizing

Isopropyl alcohol and dilute Betadine (povidone iodine) solution have been proven to be effective skin surface sanitizers against MRSA. However, as the alcohol evaporates it becomes less effective and is unable to actively protect surfaces from future contamination. Constant alcohol use can also dry the skin and decrease its natural resistance. Polysan (with TEFLEX) is a disinfectant that is also effective as a surface sanitizer against MRSA.

Hand washing

At the end of August 2004, after a successful pilot scheme to tackle MRSA, the UK National Health Service announced its Clean Your Hands campaign. Wards were required to ensure that alcohol-based hand rubs were placed near all beds so that staff could hand wash more regularly. Although alcohol-based rubs are somewhat effective, a more effective strategy is to wash hands with an anti-microbial cleanser with persistent killing action, such as Polysan or Chlorhexidine (Hibiclens).

Decolonization

After the drainage of boils or other treatment for MRSA, patients can shower at home using chlorhexidine (Hibiclens) or hexachlorophene (Phisohex) antiseptic soap from head to toe, and apply mupirocin (Bactroban) 2% ointment inside each nostril twice daily for 7 days, using a cotton-tipped swab. Doctors may also prescribe strong antibiotics such as clindamycin or levofloxacin. Household members are recommended to follow the same decolonization protocol. NOTE: posterior body openings can also be the sites of staph colonization, especially in younger people.

Conclusion

Staph infections (especially MRSA) are a potentially serious, growing problem. Swimmers and surfers can minimize their chances of developing such an infection by staying out of polluted waters, practicing good hygiene, and properly treating wounds. If you do develop a skin infection that does not improve, it's important that you promptly contact a doctor and report the case to your county or state health department. In some locations the MRSA problem has remained somewhat of a "shadow" illness due to under-reporting. In many states, MRSA is not even considered a "reportable illness."

This article is part of a series on Clean Water which looks at various threats to the water quality of our oceans, and the negative impacts polluted waters can have on the environment and human health.

For information about laws, policies, programs and conditions impacting water quality in a specific state, please visit Surfrider's State of the Beach report to find the State Report for that state, and click on the "Water Quality" indicator link.